Personalized 3D Printed Surgical Tool for Guiding the Chisel during Hump Reduction in Rhinoplasty

Summary: The authors aimed to present an introduction of patient-specific model in rhinoplasty by introducing a 3D printed surgical guide designed and adapted in an individualized manner for guiding dorsal hump reduction. To introduce the tool, we have designed a six step workflow. First, we obtain a digital 3D model of patient anatomy using computed tomography (CT) images. Second, we conduct a surgical preoperative planning of the rhinoplasty on the mentioned model. Third step consists of designing the guide, while taking into account nasal anthropometries and resection objectives. Fourth step is printing the guide and sterilizing it. Fifth step is performing the surgery. The last step is analyzing the main outcomes of the surgery. Our surgical guide allowed us to perform only 1 step osteotomy instead of the usual multistep osteotomy and remove exactly the amount of dorsum that we decided to remove during the preoperative planning. The duration of intervention was considerably shorter than conventional osteotomy. Using the guide was technically easier than the conventional method and reduced the learning curve from years to minutes (once the guide is printed). Moreover, the patient understanding of the procedure was significantly better after showing the 3D model of the surgery. The surgical guide allows a surgeon to transfer with extreme simplicity the presurgical planning to the surgical field. We have to point out that the design of the study does not allow us to quantify predictability, so future studies are needed to demonstrate an accuracy benefit over the former techniques. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Published online 8 February 2018. Received for publication September 11, 2017; accepted December 14, 2017. Presented at the CARS congress 2017, Barcelona, Spain. Supported by Hugo Herrero. Disclosure: The authors declare that they have a conflict of interest regarding the use of proprietary software (Alma 3D) that is developed by a company owned by Javier Herrero. The Article Processing Charge was paid for by Herrero Jover Médicos. Supplemental digital content is available for this article. Clickable URL citations appear in the text. Hugo Herrero Antón de Vez, MD, Department of Plastic Surgery, Herrero Jover Médicos, CM Teknon Barcelona, Vilana 12, CM Teknon, 08022, Barcelona, Spain, E-mail: hugo.herrero@dr.teknon.es Copyright © 2018 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the American Society of Plastic Surgeons. All rights reserved.

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